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A minimally invasive treatment for carpal tunnel syndrome provides complete, long-term relief to patients without the use of corticosteroids , according to research presented at the annual meeting of the Radiological Society of North America (RSNA).
Carpal tunnel syndrome is a form of nerve entrapment neuropathy, which is when one of the body’s peripheral nerves is being pressed or compressed. It occurs when the median nerves and tendons within the carpal tunnel, a narrow, rigid passageway that runs from the forearm to the palm of the hand, are being pressed or squeezed in the wrist. This results in tingling, numbness and/or weakness of the fingers and hands. Carpal tunnel syndrome is the most common and widely known form of entrapment neuropathy, affecting about 3% of the US population.
Surgery is often required to treat carpal tunnel syndrome when non-surgical methods, such as physical therapy or corticosteroid injections, are insufficient. The most common and widely used surgical method is to cut the carpal ligament to reduce pressure on the median nerve. This method requires making an incision in the wrist.
But this new study shows that a technique called hydrodissection effectively treats nerve entrapments without the need for surgery or corticosteroids. It involves injecting a fluid, usually saline, into a nerve to separate it from surrounding tissue. Ultrasound guidance is used to accurately identify nerves.
“Previously, studies that have been done on ultrasound-guided hydrodissection for carpal tunnel syndrome have used corticosteroids alone or as part of the injection, making it difficult to assess whether hydrodissection alone was beneficial or whether it was due to the effect of the steroids.” steroids,” said the study’s lead author, Anindita Bose, MBBS, MD, senior resident at Guru Teg Bahadur University College of Medical Sciences and Hospital in Delhi, India.
Ultrasound images depicting the hydrodissection procedure in a patient with carpal tunnel syndrome. (A) Needle placed under the median nerve with fluid dissecting the nerve from the underlying flexor tendons (green star). (B) Needle placed over the median nerve with fluid dissecting the nerve away from the flexor retinaculum (yellow star). (C) Image at the end of the procedure showing the dissected median nerve with fluid all over it. Red arrow: needle, blue cross: hydrodissection fluid, white dashed lines: median nerve.
For this randomized control trial, Dr. Bose and his colleagues recruited a total of 63 patients suffering from carpal tunnel syndrome. The researchers used the Boston Carpal Tunnel Questionnaire (BCTQ), the Visual Analogue of Pain (VAS), and cross-sectional area ultrasound of the median nerve to assess the patient’s pain and symptoms before and after the procedure.
The 63 patients were divided into three groups. Group one received ultrasound-guided hydrodissection with only a saline injection. Group two received ultrasound-guided hydrodissection with an injectable mixture of saline and corticosteroids. Group three received only an ultrasound-guided corticosteroid injection without hydrodissection.
Follow-up was carried out at four weeks, 12 weeks and six months. At four weeks, all three groups of patients showed a reduction in pain. At the 12-week and six-month mark, both groups receiving ultrasound-guided hydrodissection showed further improvement, while the group receiving only a corticosteroid injection reported a recurrence of symptoms and an increase in BCTQ scores. and you go.
Furthermore, ultrasound showed a significant reduction in median nerve cross-sectional area in both hydrodissection groups. Group one showed a 43% reduction and group two showed a 46% reduction. Group three showed only an 11% reduction.
The procedure is short, requiring only 10 to 15 minutes. It is also very cost-effective as it does not require any high-end equipment, Dr. Bose said.
"It was a pleasant surprise when this simple ultrasound-guided hydrodissection procedure gave patients long-term relief," said co-author Anupama Tandon, MBBS, MD, professor at the University’s School of Medical Sciences and Guru Teg Hospital. Bahadur. “Patients were very satisfied, as the cost was low, they did not need anesthesia or hospitalization, and they could return within an hour and resume their routine work.”
